Organization
EVERGREEN ACUPUNCTURE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE QUEZADA L.AC. (OWNER)
(512) 300-4047
Entity
Organization
Contact information
Practice address
3004 MEDICAL ARTS ST, AUSTIN, TX 78705-3305
(512) 300-4047
Mailing address
1710 SHELBOURNE DR, AUSTIN, TX 78752-2148
(512) 300-4047
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01203
TX
225700000X
Massage Therapist
MT038682
TX
Other
Enumeration date
01/31/2011
Last updated
01/31/2011
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